What are some things that you have been taught that is total BS?

[usafmedic45]

That's very, very interesting. I've always had my doubts about how much faster an air evac is... hmm....

You're in luck....I happen to present on this subject at conferences.

Most studies show that in most areas going by air roughly doubles the time involved be it a flight from a scene or from a hospital. Outside of REALLY rural areas (where FFEMT8978 lives is a good example, although at 3.5 hrs hours by ground, you'd almost be better off with a fixed wing air ambulance because it's faster, easier to work in and a hell of a lot safer), offshore, combat, high rise rescue, etc you're better off going by ground.

Here's some of the science:
Snooks HA, Nicholl JP, Brazier JE, Lees-Mlanga S. The Costs and Benefits of Helicopter Emergency Services in England and Wales. J Pub Health Med. 1996;18:67
-Increase in scene times
-Increase in expenses to the patient/their insurer
-No improvement in response times
-Minimal benefit

Karanicolas PJ et al: The fastest route between two points is not always a straight line: an analysis of air and land transfer of non-penetrating trauma patients. J Trauma 2006; 61: 396-403
-Longer transfer times (41.3 vs 89.7 minutes)
-Actual transport time shorter by air (58.4 vs 78.9)
-Distance of transport is not a good indicator of how long the transfer will take
-Other studies show similar delays with scene responses (Ringburg AN et al, 2007)

“They can do more in the back of the helicopter”
“Working a critical patient on board any medical aircraft- especially a helicopter- is a lot like trying to work a code in a bathroom stall at a Deep Purple concert. You don’t have a lot of room to work, what little there is taken up by other people and you can’t hear anything over the din.”- Me
-Most advanced skills are done before departure
-Studies have shown that patients benefit from the availability of ALS not from the fact it came in the form of a helicopter (Hurola et al 2002)

“It’s in our dispatch criteria.”
“Mechanism of injury!”

CALLING FOR A HELICOPTER BECAUSE OF NON-PHYSIOLOGICAL “SIGNS OF TRAUMA” IS JUST AS UNJUSTIFIABLE.
You’re basically being told you should fly someone to the hospital simply because the dent in their car is going to be expensive to repair.
A good example: The patients on board Maryland State Police Trooper 2 were both not critically injured and had been up walking around on scene talking on their cell phones prior to EMS arriving. One is now dead and the other is permanently handicapped.


....and just in case you think that relying upon the local university HEMS operator means that it's not driven solely by profit:
Rosenberg BL et al: Aeromedical service- how does it actually contribute to the mission? J Trauma 2003; 54: 681-688
-University of Michigan Survival Flight
-Roughly $6,000,000 in operating costs
-Brought in roughly $62,000,000 and was the arrival route for patients accounting for 28% of ICU days
Those arriving by helicopter were twice as likely to have private health coverage as the patients not coming in by HEMS.
“HAIL TO THE CONQUERING HEROES!”


JUST IN CASE YOU HADN'T HEARD: THERE IS NO EVIDENCE TO SUPPORT THE “GOLDEN HOUR”. It was literally named the "golden hour" because that was what the happy hour at the bar Dr. Cowley and his colleagues were hanging out at when the idea was originally suggested (as a way of encouraging funeral home ambulance services to expedite transport). Legend has it that the tenents of the "golden hour" were laid out on a cocktail napkin.

There is some evidence that prehospital interval is a poor predictor of mortality (Lerner EB et al, 2003)

 

[usalsfyre]

The real bonus in HEMS comes not from the aircraft, but the (theoretically) advanced and experienced crews that come with it. The aircraft is just an expensive, showy and dangerous way of getting there (especially in the US). So why can't we put these crews on the ground and have them run intercepts on critical calls? Because the reimbursement structure isn't built that way...

 

[usafmedic45]

So why can't we put these crews on the ground and have them run intercepts on critical calls? Because the reimbursement structure isn't built that way...

Although the FAA is getting really fed up with the industry thumbing their nose at attempts to non-legislatively (or non-administratively, to be more correct) rectify the safety and operational issues. Several of my friends work for the upper echelons of the FAA so I get to hear a lot of the internal rumblings related to safety (remember, that's my other "job"...I do safety research).

There are few things as brutal as the response when the FAA "blood quota" gets met. This refers to the old adage that flight regulations are written in blood and that a certain number of dead people (or the death of someone high profile enough) to get the FARs amended. It seems as though HEMS is getting pretty close to that and may G-d have mercy upon their souls when they finally blow off the FAA one too many times. You will see the industry gutted like a salmon between the front paws of a grizzly. Cheap, fly-by-night operators like AirEvac Lifeteam (sardonically know among my NTSB friends as "ScareEvac Deathsquad"; you've got a serious problem when you have the worst safety record of any operator in an industry best known for a poor safety record) will disappear faster than they sprang up when the medical reimbursement regulations were loosened. The industry will wither away and all because they put profits before safety.

 

[usalsfyre]

I count my blessings every day that I didn't end up splattered all over a cow pasture when a 206L proved yet again it wasn't up to the job. I may not have wanted to leave when I did, but it was probably the best thing that ever happened to me.

 

[katgrl2003]

Puh-lease... as a dispatcher, I can tell you I would probably slap a coworker if they tried to tell a crew where to go or not go. What right does an EMD-trained layperson miles from the patient have telling a paramedic what facility they need to take the patient in front of them to?

Was that an IFT gig?

Yup. Dispatcher asked us to call when we were done with the run... I lasted 2 minutes with her berating me before I hung up on her.

 

[rwik123]

look at that mechanism of injury!

[YOUTUBE]http://www.youtube.com/watch?v=YzYxz_uvtSI[/YOUTUBE]

 

[johnrsemt]

Where I am now, I am 45 min from a Level III, and 90 from 2 Level I's and a Level II. So we do use helicopters more here than I did while I was in Indy; but they aren't needed as much as they are called for. and we have some medics who sit on scene and wait for them to come to us, instead of meeting us 1/2 way.
So while they are waiting if they find out that the bird can't come then they are even more time from the Trauma Centers.

 

[lightsandsirens5]

We're an hour from the nearest hospital here, and it is a 30 minute flight for the helo. The only time the helo makes a difference for us is getting a patient to a level 2 trauma center which is 3 hours by ground, or 3.5 hours to a level 1.

You are only 3.5 from Harborview?

 

[CAOX3]

Nothing better then canceling a helicopter because some over zealous firefighter decided it was necessary to close a five lane highway and land the whirly bird without ever laying eyes on the patient.

The conversation went something like I don't tell you how to vent a roof, you don't tell me who needs to go by helicopter, we base treatment and transportation on assessment not your desire to get your rocks off. He then stated well you wait until the medics get here, I said you will be waiting a while because I canceled them too.

He filed a complaint with my service, which didn't go anywhere because the kid was discharged an hour after arrival with a sprained ankle.

 

[Hal9000]

According to the three ALS services around here, "cold steel and flashing lights are what save a cardiac arrest—that's why we transport." All three services transport all codes. They're also convinced that CPR is as effective in the back of an ambulance zooming about code 3.

I'd feel like Sisyphus if I were try to detail all the things I hear...the life-saving capabilities of the spineboard...driving code being 10 times as safe as driving one's personal vehicle in normal traffic...driving code "because that's what an ambulance is for."

Too wearying to try.

 

[usalsfyre]

What does cold steel do for non-traumatic arrest?!? More like "zappy defibrillators and muscular CPR save cardiac arrest". Heck, hot lights and cold steel are increasingly not indicated for trauma.

Some people are just morons. Glad to see you don't buy into the idiocy.

 

[ffemt8978]

You are only 3.5 from Harborview?

Code 3 on the interstate, yeah.

 

[usafmedic45]

Nothing better then canceling a helicopter because some over zealous firefighter decided it was necessary to close a five lane highway and land the whirly bird without ever laying eyes on the patient.

He filed a complaint with my service, which didn't go anywhere because the kid was discharged an hour after arrival with a sprained ankle.

I had an air ambulance crew try that when I told them to get off my scene. They contacted my medical director (or rather their PR/"education"/"quality control" department did) and said something about me depriving the patient of a higher standard of care. I was present for the phone call and my medical director literally laughed out loud and then simply said "I won't say anything about you showing up without being called if you don't say anything about my EMS personnel being well educated. Now kindly, **** off" and hung up.

The conversation went something like I don't tell you how to vent a roof, you don't tell me who needs to go by helicopter, we base treatment and transportation on assessment not your desire to get your rocks off. He then stated well you wait until the medics get here, I said you will be waiting a while because I canceled them too.

According to the three ALS services around here, "cold steel and flashing lights are what save a cardiac arrest—that's why we transport." All three services transport all codes. They're also convinced that CPR is as effective in the back of an ambulance zooming about code 3.

I'm famous for asking people who fly aircraft with horrible safety records (such as the Cirrus line of aircraft) to sign releases authorizing me to have access to their autopsy reports for my research. Turning that paperwork into a medical examiner or coroner is always fun: "You have a what? How?"

Maybe I should start doing the same thing to EMS providers who work for services like the one you are describing.

Heck, hot lights and cold steel are increasingly not indicated for trauma

 

[Hal9000]

What does cold steel do for non-traumatic arrest?!? More like "zappy defibrillators and muscular CPR save cardiac arrest". Heck, hot lights and cold steel are increasingly not indicated for trauma.

Some people are just morons. Glad to see you don't buy into the idiocy.

I think you got the phrasing right on that—it did involve hot lights, not flashing ones. It was the first time I'd heard such a nonsensical statement, so please forgive me for not recalling it correctly.

There seems to be a persistent miasma of medical folly around me. I'm once again back to a paid ALS service that considers it appropriate to dash in to whatever scene immediately, then waste time having one person playing fetch from the ambulance. Now that I have a college education, I only have a few more months that I have to stay in EMS, and I'll hopefully be done for good. My current service is 9-1-1 almost exclusively and pays darn well for a private, so I'm willing to stick with it for now.

The lack of education amongst "advanced" providers here really throws me off. I was recently interacting with an ALS crew that hadn't even heard of CCR, and this happened to be with one of the services that transports dead people. I suppose I'd not be inclined to rant, but when an ALS provider with zero collegiate medical knowledge tries to "educate" me on medicine, I become somewhat perturbed.

With some of the extremely messed up volunteer services I've taken part in, I could understand the amount of retardation.* With paid ALS services that interact constantly with hospital emergency departments, it's just strikingly inexcusable. I hate hearing things like, "every patient gets an IV because the hospital says so," and the same reason for backboarding all trauma patients.

The best one in the past couple of days was, "sores from backboards don't really hurt much and they should be the last concern for a person being backboarded anyway." I quite literally had to stop my hand from striking my face.







*(Proud to say that I corrected the most awful one, which is now a rural service offering paramedic service and critical care transports staffed by providers with bachelor's degrees, in lieu of having HEMS fly everything, starting with verdant rhinorrhea.)

 

[shfd739]

Nothing better then canceling a helicopter because some over zealous firefighter decided it was necessary to close a five lane highway and land the whirly bird without ever laying eyes on the patient.

The conversation went something like I don't tell you how to vent a roof, you don't tell me who needs to go by helicopter, we base treatment and transportation on assessment not your desire to get your rocks off. He then stated well you wait until the medics get here, I said you will be waiting a while because I canceled them too.

He filed a complaint with my service, which didn't go anywhere because the kid was discharged an hour after arrival with a sprained ankle.

This is fun to do. Alot of our FDs always want to launch a helicopter even though we can go ground and save time or be just as quick. For the most if the helicopter isn't on the ground when we get onscene we are going ground. There have been a few times they were in sight or final and we still went ground as it was still quicker once load/unload times were factored in.

 

[mycrofft]

Lots of off thread reactionary stuff here.

(Do I love a stomping or what?).
Not that the basic points are wrong, but some of the statements are wrong in some cases. In our local mountains, and across the more-remote areas of the Califorina Delta, and in times of flood around here, a helo can be a much better direct transport than a groundulance once they get there. They need to run helos with utmost professionalism, and use choppers which are up to the job, and staff and dispatch them in a manner which doesn't add delay. In the purely urban, or suburban, scenario the majority of calls cover and the majority of our fellow website users work in, yes, helos are an extravagance and sometimes a real danger.

Worthless advice or training I was given...

Nearly everything about snake bites.

Never apply a tourniquet except if the limb is torn off. (In fact, tearing off the limb is more likely to cause arteries to stretch then contract than cutting them does).

Carry a towel clamp to gain control of a pt by clamping onto the nasal septum. (I call that the "OhMoe" device):

Don't ready the AED while the pt is alert, it will scare them into a heart attack for sure.

Take everything the pt says at face value.

Oh, yeah. mastoid bruising and black eyes are a rapid sign of cranial fracture.

 

[Hal9000]

Good point about HEMS in rural settings.

Very needed in Montana in many cases...of course, one company has/had a HEMS activation policy for any MVC rollover outside the town limits. Flying a patient 4.39 nautical miles is pretty silly.

Flying a patient from a skidder accident 50 nm is very reasonable.

 

[usafmedic45]

Flying a patient from a skidder accident 50 nm is very reasonable.

Depends on what those 50 miles consist of. 50 miles of highway is a totally different animal versus 50 miles on a one lane logging road. The general rule I teach is that if you can get the patient to the hospital in under 90 minutes by ground, then you'll probably beat the helicopter. Think in terms of time and not distance.

 

[Hal9000]

Depends on what those 50 miles consist of. 50 miles of highway is a totally different animal versus 50 miles on a one lane logging road. The general rule I teach is that if you can get the patient to the hospital in under 90 minutes by ground, then you'll probably beat the helicopter. Think in terms of time and not distance.

Well, there aren't all that many skidder accidents in NW Montana that have 50 highway miles.

This particular one would have been 50 logging road miles plus 50 highway miles.

EDIT: I should add that I've heard a helicopter launch for CPR in progress medical. I don't know why they'd do that, and it seemed so strange that I almost figured that they must have had some other reason for it.

 

[usafmedic45]

Well, there aren't all that many skidder accidents in NW Montana that have 50 highway miles.

This particular one would have been 50 logging road miles plus 50 highway miles.

That's what I figured you were getting at, but we have a lot of really stupid EMTs and medics on here who would think that just 50 highway miles is justification enough. Therefore, I decided to inquire further.